Dr Haja Wurie is based at the College of Medicine and Allied Health Sciences in Freetown, Sierra Leone. In this HEART talks video she describes the rebuilding of health systems in the post-conflict period in Sierra Leone as ‘fire-fighting’. This meant that the response did not adequately capture gender. Ensuring service provision for women and children was in the plans but was not clearly implemented. In 2010 Sierra Leone had one of the highest maternal mortality rates in Africa. The statistics encouraged the political and international community to introduce free healthcare. In 2013 the maternal mortality rate in Sierra Leone had risen. With the free healthcare, a lot of emphasis was put on service delivery, producing low-cadre health workers rather than qualified mid-wives.

Early Ebola response did not incorporate gender analysis. However, there is still an opportunity there. The recovery plan has been divided into segments looking forward to different time-periods. Gender needs to be incorporated into the five-year plan.

Donor humanitarian and health advisers must talk about promoting gender issues in the immediate reconstruction of the health system for things to happen. There is a general conception that gender issues are not seen as much of a problem among decision-makers. Inadequate resources are being put into addressing gender-based violence, for example. If the international community make sure they talk about gender when they are meeting ministry officials, the importance can filter in to decision-making. DFID advisers working on gender, health systems and resilience need to go in understanding the context. They need to support community-based organisations and use a more bottom-up approach. Grass-roots communities can give a better understanding of the context and they have the advocacy and voice to ensure that the issue of gender is incorporated into health systems strengthening.

For more on gender and post-conflict health systems see other HEART talks in this series:

• Sarah Ssali on understanding gender issues in health systems strengthening in post-conflict Uganda
• Valerie Percival on the importance of understanding gender equity in humanitarian responses to health issues
• Rosemary Morgan on gender in health systems research
• Group interview with Sarah Ssali, Sally Theobald, Rosemary Morgan and Asha George on essential gender issues in relation to health systems.